Miscarriage Care and Facilities in Scotland: Scoping Report NHS Fife

Dedicated facilities

Unexpected pregnancy complications at any gestation

The Scottish Government has committed to the provision of dedicated facilities for women experiencing unexpected pregnancy complications through the Programme for Government 2021-22^[6]. All sites were asked if they currently provide dedicated facilities for women experiencing unexpected pregnancy complications at any gestation. Sites with an EPU were also asked to indicate if they currently provide dedicated facilities for women experiencing unexpected pregnancy complications at any gestation within the EPU.

Within NHS Fife, Victoria Hospital indicated that they currently provide dedicated facilities for women experiencing unexpected pregnancy complications at any gestation both within and outwith the EPU (Table 12).

Separate room/area/ward

All sites in Scotland were asked if they provide a separate room, area, or ward away from the labour ward for women that are miscarrying. They were also asked if they provide a separate room, area, ward or unit with dedicated services to admit women who are miscarrying. The number of separate rooms reported to be available for women who are experiencing miscarriage ranged between 1 and 12 rooms per site in Scotland.

In NHS Fife it was reported that patients from the entire Health Board area are referred to Victoria Hospital through a variety of pathways: self-referral, GP referral, A&E, antenatal clinics or from community midwives. They reported that there are dedicated facilities for women experiencing unexpected pregnancy complications at any gestation. They also said that there is a separate room/area/ward for women who are miscarrying. There are nine rooms available on the gynaecology ward for women who are miscarrying. The facilities that are provided are set out in Table 12 above. These facilities are located both within and outwith the early pregnancy unit at Victoria Hospital. These spaces are also available for use for women experiencing ectopic and molar pregnancies. Women experiencing still births or termination of pregnancy due to fetal anomaly (TOPFA) are accommodated with bereavement rooms in Obstetric Labour Ward.

Scanning facilities

Scans are often performed to confirm a miscarriage has occurred. For this scoping exercise all sites were asked if a separate area was available to carry out complication or investigative scans separated from women with a continuing pregnancy.

Overall, 7 out of the 14 Health Boards reported having a separate area to carry out complication/investigative scans separated from women with a continuing pregnancy, either within or outwith the EPU.

Victoria Hospital reported that scans are conducted in the Early Pregnancy Unit during opening hours. If a woman presents with a suspected miscarriage out of hours and a scan is required, the patient would be referred to the EPU during opening hours the next day if she is stable. When a woman presents out of hours and is not stable an investigative scan would take place within the A&E department, maternity unit or obstetrics and gynaecology by an appropriately qualified member of medical staff if they are available. Scans are not routinely undertaken within the Maternity Unit and Obstetrics and Gynaecology Department, but the facilities and staff are there for sporadic scans when clinically needed. However, even if the emergency medical team carry out the scan, a conclusive scan may be required in the scan department the following day.

Victoria Hospital stated that they do not have a separate area to carry out complication/investigative scans separated from areas for with a continuing pregnancy either within or outwith the EPU and attributed a lack of space, staff recruitment, staff retention, staff training and finance/cost as barriers to providing this.